Radical resection of cancerous tissue during surgery is critical to reduce tumour recurrence, and thus improve the life expectancy of the patient. In pursuing this goal, radio-guided surgery (RGS) represents a significant surgical adjunct to intraoperative detection of millimetric tumour residues. The goal of this project is to develop a novel radio-guided surgery (RGS) technique based on ß- radiation emission, which corresponds to a change of paradigm, since ß- radiation is currently used only for therapy due to its short tissue penetration. Intraoperatively, this feature can be exploited because it reduces the amount of background radiation from the adjacent radioactive tissues and organs, permitting the possibility of developing more compact probes, subsequently reducing the radiation exposure of the medical personnel. This technique has been studied so far with laboratory tests and simulations with very promising results confirmed by proof-of-principle clinical tests on meningioma with Y-90 labelled DOTATOC. This project aims at extending the technique by developing a detector that can be used in endoscopic applications and by carrying on the research of an innovative probe to be utilized in a endoscopic environment and by synthetizing a new radio-tracer suited for endoscopic approaches on head and neck tutors.
Since cancer is a major cause of global morbidity and mortality, developing a tool aimed at reducing its recurrence has an enormous impact on the society and the health care system. The strength of this project is that it is based on a change of paradigm that opens the path to unexplored possible improvements over the existing techniques, and is an improvement of a well-established medical procedure. Furthermore, the group performing the research includes physicists and physicians, partners that can guarantee a translational approach. It can focus on the industrialization of the technique for global welfare , in the short term, and full exploitation of the unique information available with the proposed detection system within the context of image guided and robotic assisted surgery, in the medium term.
A new in vivo diagnostic tool and method
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The expected outcome is a new radio-guided surgery technique along with the corresponding probe and visualization/guidance system. The technique is aimed at improving surgical decisions towards a full resection of the tumour, whilst sparing healthy tissue. In the case of head and neck tumors, the morphology of the area of interest is such that a compact device is needed to assist the surgeon where the visibility is not optimal. On the other side the lymphatic chains in the head and neck district are overlapped and difficult to follow, so that the availability of a local probe would be critical in the search for sentinel lymph-nodes.
It is also to be noted that once a selective detector for low energy charged particles is available, a large number of applications in other fields could be considered, from national security to non destructive tests or nuclear wastes.
Contribution to the sustainability of health care systems
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A reduction of recurrences in tumors is desirable both for the patients health and for the sustainability of the health-care system. Improvements in tumour resection, have indeed been shown to correlate with either time to tumour progression or overall survival. Furthermore, this proposal aims at extending the use of laparoscopy, thus reducing the need for open surgery and the consequent socio-economic burden on the health care systems. Furthermore, the assessment of this novel technique would open the path to further applications, all in the direction of increasing the sustainability of the health care systems.
Dissemination
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By itself the development of a novel technique has its visibility also within the general public, as proven by the press release that was issued already in these few years of development of the idea. In addition our team has already a tradition of attendance to all major conferences in particle physics, detector physics, chemistry and nuclear medicine to create the research network needed for such a trans-disciplinary activity. It is then to be stressed the educational potentiality of such a team and indeed all students that graduated in applied physics with us managed to get Ph.D. positions or jobs in the field of medical applications.